Transitioning to Gabapentin Enacarbil

[grizzly99]

I need some advice when it comes to starting Horizant while moving away from Pramipexole. I've been on Pram for about 12 years and although it still works generally, it's getting less an less effective. So it's time to move on.

Gabapentin Enacarbil (Horizant) is what I'm moving to.

My question to the group is: has anyone done this and can offer some insight? and should I overlap the drugs for a week or so or slowly taper down the Pram until gone?

Primary Care phy says since they work in 2 different ways, it's OK to overlap, but didn't give much guidance on how to do this.

Thanks in advance to any who want to wade into the topic.

Grizz

[SueJohnson]

Start it 3 weeks before you are off pramipexole although it won't be fully effective until you have been off it for several weeks and your symptoms have settled.

Take at 5:00 pm with food because the bioavailability is greatly increased (33% to 118%, depending on the meal's fat content.

Start at 300 mg per day and increase to 600 mg as needed. If not effective can increase to 1200 mg. More side effects with increased dosage.

It shows improvement within a few days and continues to improve for about another week.

Their Prescription Savings Card is available for eligible patients and you pay as little as $55/month if you have no insurance for 30 tablets and as little as $0/month up to 60 tablets if you do have insurance. If not eligible I have another source for about the same cost.

[grizzly99 in reply to SueJohnson]

Good guidance, Sue. Thanks. My main concern is the sedative effect of combining these . Also, during the 3 week overlap period, can you offer any suggestions regarding the tapering off of the Pram?

Have a great week!

[SueJohnson in reply to grizzly99]

The same as you are hopefully doing now. Reducing by .125 mg every 2 weeks. If that is still too much to reduce, you can get an inexpensive jewelry scale that measures down to .01 gram from Amazon ($11 in the US) and shave off a bit of the tablet and measure it. Then reduce by that amount every 2 weeks. If you can get your doctor to give you a low dose opioid temporarily to help out with the symptoms especially as you near the end that would be best.If not some have used kratom or cannabis temporarily to help.

Most people would love the sedating effect as they can't sleep.

[grizzly99 in reply to SueJohnson]

Thanks, Sue!

[RiversW in reply to SueJohnson]

Hi Sue, when you say the bioavailability is greatly increase depending on the fat content of the meal does higher fat content increase or lower bioavailability? Thank R

[SueJohnson in reply to RiversW]

Increases it.

[RiversW in reply to RiversW]

Thank you.

[707twitcher]

DAs can cause permanent damage to dopamine receptors, and this can result in gabapentoids not working for some people. I, too, was on Pramipexole for 12 years. I tried going on pregabalin while tapering down, but that didn’t help. Hydrocodone helped, but only at a larger dose - 15mg. What really helped was buprenorphine. Instant relief. One month after being off Pramipexole I tried pregabalin again but it actually made my symptoms worse. I’ll likely stay on buprenorphine indefinitely.